Understanding trends in emergency care

Admitting a patient to hospital as an emergency case is costly and often avoidable, yet the number of emergency hospital admissions has been rising for some time. We examined the reasons for the rise and assessed the likely impact as the NHS in England faced a period of constrained growth in its funding.

Approximately 35 per cent of all admissions in the NHS in England are classified as emergency admissions. This costs the NHS approximately £11 billion a year.

Yet despite the known rise in emergency admissions, and the huge costs they generate, there has been insufficient systematic analysis of what lies behind the rise across England.

Our researchers have attempted to fill this gap by examining in detail the rise in emergency admissions in England from 2004/05 to 2008/09.

The number one issue facing the NHS in England is reversing the ‘unsustainable’ rise in emergency hospital admissions

They found that the rise had occurred in patients across all age groups, and across a range of diagnoses. It is estimated that treating these extra patients in emergency hospital care is costing the NHS an additional £330 million per year.

The Nuffield Trust has set out a number of possible explanations for the rise. A key finding from the analysis was that the overall rise was linked with a dramatic increase in the number of short-stay admissions – those patients that are admitted as an emergency for one day or less. The short length of stay of the extra cases suggests that less severe cases are being admitted, implying that the threshold for emergency hospital admission has lowered in the last five years. Lower mortality in admitted patients also suggests the same.

The authors also found that selected central policy initiatives and targets did not seem, in of themselves, to have had an obvious effect in accelerating the rate of emergency admissions in England.

The rise in emergency admissions continues to be a major concern to the NHS in England, with efficiency savings of 4 per cent per year required up to 2015.

The Nuffield Trust will maintain an interest in this issue and will conduct further analysis in the future.